Christine Migliorini

Comparison of depression, anxiety and stress in persons with traumatic and non-traumatic post-acute spinal cord injury.

Study design:Community cross-sectional self-report survey of adults with spinal cord injury (SCI).Objectives:The aim of this study was to examine the likelihood of depression, anxiety and stress in adults with non-traumatic SCI (NT-SCI) compared with adults with traumatic SCI (T-SCI).Setting:Victoria, Australia. Adults (N=443; NT-SCI n=62) living in the community and attending specialist SCI rehabilitation clinics.Methods:Participants completed a self-report survey by internet, telephone or hard copy. Items included demographic and injury-related characteristics and the short form Depression, Anxiety and Stress Scale (DASS-21).Results:Persons with NT-SCI were significantly more likely to be female (P<0.05), older (P<0.001) and have lower-level incomplete injuries (P<0.001). The probability of depression, anxiety or stress in respondents with NT-SCI did not differ from persons with T-SCI (P>0.05). Overall, the prevalence of adverse mental health problems defined by scoring above DASS-21 cutoffs, were depression 37%, anxiety 30%, and clinically significant stress 25%.Conclusions:This study examined multiple mental health outcomes after NT-SCI in Australia. This study provides some evidence that the results of studies of depression, anxiety or stress in persons with T-SCI can be generalised to those with NT-SCI in the post-acute phase. NT-SCI patients are also at substantial risk of poor mental health outcomes. General demographic and injury-related characteristics do not seem to be important factors associated with the mental health of adults with SCI whether the SCI is traumatic or non-traumatic in origin.

Quality of life in adults with spinal cord injury living in the community

Study design:The study design used is cross-sectional descriptive survey.Objectives:The aim of this study is to describe the subjective and objective quality of life (QoL) of adults with chronic non-traumatic spinal cord injury (NT-SCI) and to compare the objective and subjective QoL of adults with chronic NT-SCI with adults who have a chronic traumatic spinal cord injury (T-SCI) and the general population.Setting:Living in the general community (non-residential care), Australia.Participants:The study included 443 adults with SCI (T-SCI, n=381) (NT-SCI, n=62), all SCI ⩾6months duration.Intervention:Not applicable.Main Outcome Measures:Objective and subjective QoL domains—Comprehensive QoL Scale for Adults, version 5 (COMQoL-A5); acceptance subscale—the Spinal Cord Lesion Coping Strategies Questionnaire, version 1 Australia (SCL CSQ v1.0 Australia).Results:Despite demographic differences, only the objective QoL domain material (higher in NT-SCI) and the subjective QoL domain health (lower in NT-SCI) were significantly different between the SCI subgroups. In contrast, five of the seven objective domains and four of the seven subjective domains were significantly lower in the SCI sample as a whole, compared with the general population. Post hoc analyses suggested that aetiology of the SCI was not responsible for QoL differences within the cohort with SCI.Conclusion:On the whole, aetiology makes little difference to QoL outcomes after SCI. The QoL of adults with chronic T-SCI and NT-SCI fall significantly below that of the general population in most domains.

REFLECTING ON SUBJECTIVE WELL-BEING AND SPINAL CORD INJURY*

OBJECTIVE The aim of this study was to examine factors associated with the subjective well-being of individuals with spinal cord injuries, while acknowledging theories that describe the subjective well-being tendency to homeostasis. METHODS A representative community cross-sectional cohort of 443 adults with traumatic and non-traumatic spinal cord injury completed a self-report survey (by internet, telephone or hard copy) that included reliable and valid measures of quality of life, depression, anxiety and stress, post-traumatic stress disorder, coping strategies, and emotional consequences. RESULTS The subjective well-being of half of the population with spinal cord injury lay above the normative subjective well-being set-point threshold. Despite the inclusion of many biopsychosocial factors, only Intimacy, Safety, Acceptance, and Helplessness were significantly associated with normative subjective well-being. CONCLUSION Comparatively few factors were significantly associated with normative subjective well-being, but the results help to explain observed contradictions noted in previous research into subjective well-being after spinal cord injuries. The results highlight the resilience of individuals in general and are in keeping with the disability paradox. However, many individuals with spinal cord injuries do not live satisfactory lives. It is for them that further psychological care and rehabilitation is necessary to create a good life after spinal cord injury.

Preliminary investigation into subjective well-being, mental health, resilience, and spinal cord injury

Abstract Objectives To undertake a pilot investigation into whether individuals whose subjective well-being had returned to the normal homeostatic range after a spinal cord injury (SCI) may be more resilient and therefore, at less risk of emotional distress over time. To consider the relative stability of subjective well-being in individuals with chronic SCI whose subjective well-being had previously returned to the normative homeostatic range. Study design Longitudinal study: Time 1 (T1) 2004 and Time 2 (T2) 2009. Setting Victoria, Australia. Participants Participants were adults living in the community with chronic SCI, who had no mental ill-health symptoms at T1. Outcome measures Scales include: Comprehensive Quality of Life Scale – Adult v5 (COMQoL-A5) at T1, Personal Well-being Index (PWI – the successor to the COMQol-A5) at T2, and Depression, Anxiety & Stress Scale – short form (DASS-21) at T1 and T2. Results Twenty-one adults participated at T1 and T2. Subjective well-being was stable for 57% of the cohort. However, 19% presented with symptoms of emotional distress by T2. There was no significant difference in age (P = 0.94) or time since injury (P = 0.51) between those reporting significant emotional symptoms and those without; nor was there any systematic change in health status. Conclusion This study yielded two important findings. First, individuals with chronic SCI may be vulnerable to mental health issues even after they have previously exhibited good resilience. Second, subjective well-being after SCI may not be as stable as suggested by the general quality of life literature that have examined genetic and personality connections to subjective well-being.

Translation and Australian validation of the spinal cord lesion-related coping strategies and emotional wellbeing questionnaires

Study design:Representative community cross-sectional self-report survey of adults with spinal cord injury (SCI).Objectives:To establish semantic translation and validation of the Swedish scales—the Spinal Cord Lesion Coping Strategies Questionnaire and the Spinal Cord Lesion Emotional Wellbeing Questionnaire.Setting:Adults on the Victorian traumatic SCI register and attendees of the nontraumatic outpatient clinic were invited to participate.Methods:Instruments were forward and backward translated to establish semantic equivalence. Principle components analyses were undertaken. Correlation and logistic regression analyses were conducted to demonstrate validity of the instruments using both positive (high quality of life) and negative (depression and anxiety) psychological outcomes.Results:The final sample consisted of 443 adults with SCI living in the community. Both instruments demonstrated acceptable psychometric properties. Univariate correlation analyses showed most of the new scale components displayed medium to large relationships in the expected direction with the psychological outcomes and the other subscales. Health status and helplessness were significant predictors of both the positive and negative psychological outcomes in the logistic regression analyses. Acceptance was significantly related to the positive outcome only. Female and incomplete tetraplegia categories were significantly and positively related to depression only.Conclusion:Notwithstanding a few issues with some of the subscales, the results support the usefulness of these easy to use instruments and point to ways for further development of the scales.

Prevalence of mood disturbance in Australian adults with chronic spinal cord injury

There is little understanding of the prevalence of mental health issues in people with spinal cord injury (SCI) after they leave rehabilitation or how mental health issues can alter over time.

Piloting an email-based resource package for job seekers with multiple sclerosis

Abstract Purpose: Media-based rehabilitation provides a powerful opportunity to examine vocational behaviors in the disability sector. However, this research is preliminary at best. This paper reports pilot data. Method: Eighteen adults with multiple sclerosis (MS) accessed an email-delivered, resource-based package, Work and MS. Pre- and post-access vocational self-efficacy and identity (Job-Procurement Self Efficacy Scale, My Vocational Situation Scale- primary outcomes), life orientation and depressed mood (Life Orientation Test – revised and Patient Health Questionnaire-9 – secondary outcomes) were assessed. Pre- and post-change scores were examined with Wilcoxon signed ranks tests and Hedges g effect sizes with associated 95% confidence intervals. Reliable change analyses were additionally calculated to determine the clinical significance of individual change scores. Results: Significant and positive effects were reported for vocational self-efficacy, identity, and optimism. Reliable change scores in one or more of these key outcomes were reported by 30% of the sample. Satisfaction with the content and delivery of the email-based intervention was also noted. Conclusions: Preliminary evidence suggests that Work and MS can help to promote vocational goals, interests and strengths among job seekers with a disability by providing a set of tools, information and linkages relating to vocational pursuits and career development. Replication with a randomized control design is indicated. Implications for Rehabilitation Research indicates a high unemployment rate among working-age adults with MS. A combination of disease-specific, psychological, programmatic and societal variables contribute to employment instability in this group. This pilot study demonstrates that an e-mail-based resource package, Work and MS, provides an innovative and feasible option for promoting consumer engagement with vocational services and, potentially, improving vocational outcomes. Work and MS has potential applicability to other disability groups.

A randomised control trial of an Internet-based cognitive behaviour treatment for mood disorder in adults with chronic spinal cord injury

Study design:Prospective parallel waitlist randomised controlled trial.Objectives:Evaluate the feasibility and effectiveness of an Internet-based psychological intervention treating comorbid mood disorder in adults with spinal cord injury (SCI). Improved mood and satisfaction with life were primary outcomes.Setting:Victoria, Australia.Intervention:Electronic Personal Administration of Cognitive Therapy (ePACT).Measures:Depression, Anxiety and Stress Scale–Short Form (DASS21), Personal Well-being Index, Helplessness subscale of the Spinal Cord Lesion Emotional Well-being Scale v1 Australia, at each time point.Participant qualifying criteria:Adults (18–70 years), chronic SCI, attend SCI review clinic at Austin or Caulfield Hospital and score above normative threshold of the Depression, Anxiety and Stress Scale–Short Form (DASS21).Methods:Forty-eight participants completed Time 2 post intervention (n=23) or time equivalent for waitlist control group (n=25) telephone interviews. The measures were repeated a third time (Time 3) for a small subgroup (n=12) at 6 months post intervention within the study implementation time frame.Results:Univariate within group analyses revealed significant improvement in mood in the intervention group at Time 2: (lower depression (effect size (ES)=0.4), anxiety (ES=0.4) and stress (ES=0.3)) and higher satisfaction with life (ES=0.2). Waitlist control group improved in depression only (ES=0.3) by Time 2. Multilevel variance components analyses, although not as positive, were still encouraging. Improvement in mood symptoms was maintained in the small group reinterviewed at Time 3.Conclusion:Although Internet-based interventions for mental health issues in SCI not a solution for all, our results indicate that they are a potentially valuable addition to the currently available options.

Community integration questionnaire: Outcomes of people with traumatic brain injury and high support needs compared with multiple matched controls

Abstract Objectives: To determine level of community integration in adults with traumatic brain injury and high support needs (TBI-HSN) compared with multiple matched controls. Setting: Community setting, Victoria, Australia. Participants: Adults with TBI-HSN living in the community (n = 61). Australian normative data (n = 1973) was used for matching purposes (1:4). Design: Matched analysis from people with and without TBI. Matching aimed to reduce variability expected from age, gender, metropolitan/rural residence and co-resident status. Main measures: Community Integration Questionnaire (CIQ): total and sub-scales of Home Integration, Social Integration and Productivity. Results: Matched analysis showed large effects favouring the general population, e.g. CIQ total scores were significantly different, F(1, 304) = 5.8, p < 0.0001. Conditional relative risk showed community-dwelling participants with TBI were 540-times more likely to report a poor CIQ total score compared to the general population. Conclusion: Normative CIQ data has enabled meaningful comparisons of the community integration of adults with chronic TBI to the general population in Australia. Evidence makes clear with numeric precision that individuals with TBI and high support needs are much less integrated than their non-TBI counterparts despite living in the community for many years.

Can targeted job-information for adults with spinal cord dysfunction be effectively delivered online? A pilot study

Objective: To pilot a novel email-based information package (Work and SCI) for job-seekers with an acquired spinal cord injury (SCI) or spinal cord dysfunction (SCI/D). Study design: Prospective, non-randomized, repeated measures trial. Setting: Community dwelling cohort in Australia. Participants: Five people with SCI (mean age 46.4 years, SD = 10.2; 4 female) initially reviewed Work and SCI. Twenty-four with SCI/D subsequently enrolled, of whom 16 (mean age 46.4 years, SD = 11.1; 7 female), completed the intervention. Intervention: Intervention participants accessed Work and SCI over a 4-week period. Outcome measures: Individual changes in pre-post scores for the My Vocational Situation Scale, Job Procurement Self-Efficacy Scale, Patient Health Questionnaire-9 and Life Orientation Test-Revised were examined. Results: Reliable change in pre-post scores across outcomes were reported by 38% (n = 6) of participants. Favorable comments on the Work and SCI resource were provided in addition to suggestions for improvement. Conclusions: Preliminary data suggest that Work and SCI may help to establish vocational interests among job-seekers with a SCI/D, however further work is needed to enhance participant compliance. This might include moderator support to promote and maintain participation. A controlled design will also help to identify factors that influence engagement with the Work and SCI resource.